Guest Form

    18+ Holiday to Wales

     

    Your Details

    Next of Kin Details

    Emergency Contact Details

    If next of kin are going abroad during the holiday please add a contact in the UK.

    GP Details

    Guest Information

    Medical Conditions

    Please indicate if you have any of the following:

    If so, when was the date of your last seizure: How often are your seizures?
    If yes, please provide details:
    If yes, please provide details:

    I need assistance in the following areas

    Care Plan

    Medication

    Additional Information

    Preferred Travel Arrangements

    Under the data protection regulations 1998 and to comply with new regulations coming into effect from 25 May 2018, we need your consent in respect of the following, and would be grateful if you would select your agreement using the dropdowns provided:

    Under the new regulations you have the right to request personal data held about you by us and following your request this information will be returned to you within a month.

    3H - Helping Hands for Holidays